Ultrastructural and in vivo confocal microscopic evaluation of interface after Descemet's Stripping Endothelial Keratoplasty in rabbits

Purpose: To study healing at the donorrecipient interface after Descemets Stripping Endothelial Keratoplasty (DSEK) in rabbits by ultrastructural and in vivo confocal microscopic evaluation. Methods: The right eye of eight New Zealand White rabbits underwent DSEK. Postoperatively, each rabbit was subjected to routine slitlamp examination daily for 2 weeks and then weekly for 6 weeks. In vivo confocal microscopic evaluation was performed at 1, 2, 4 and 8 weeks. Two rabbits were randomly chosen at 1, 2, 4 and 8 weeks for transmission electron microscopic examination. Results: Interface haze decreased with each follow-up visit. Activated keratocytes and associated cellular processes were evident throughout all the followups with in vivo confocal microscopy. Highly reflective particles were left at the interface until the end-point of the study. Upon ultrastructural evaluation, increased rough-surface endoplasmic reticulum in keratocytes, clefts, folds and retained Descemet's membrane (DM) were found. Conclusion: Clefts lack of adherence at the interface and degenerated keratocyte may make up the highly reflective particles. In addition, retained DM does not appear to affect adhesion and very minimal healing is produced at the DM-stroma smooth interface, which permits better quality of vision in Descemet's membrane endothelial keratoplasty.